Pediatric Skull and Spine Deformities
A child’s head may be misshapen for a number of reasons, including growth patterns and pressure on the skull before, during, and after birth. Spinal deformities in children, often identified when they are older, are usually marked by a curvature or rounding of the spine, or a weakening or fracture in parts of the spine. Those conditions all require careful monitoring. Some are resolved through surgery, which can clear the way for normal growth and development.
At Yale Medicine, doctors work with several different departments to ensure the best diagnosis and treatment for patients.
What are examples of common pediatric skull and spine deformities?
Skull deformities. The skull is made up of seven bones that are held together by seams known as cranial sutures. As a baby grows, these sutures make it possible for the skull to expand to accommodate the growing brain, until they fuse at about 2 years old. If one or more of the sutures closes too quickly, the brain is forced to grow in a direction where the bones are not resisting it. This results in a condition known as craniosynostosis. There are several types of craniosynostosis—each is identified by the sutures of the skull that are affected.
Spinal deformities. The most common pediatric spinal deformities are scoliosis, kyphosis, and spondylolysis. Scoliosis and kyphosis result in unnatural curving of the spine, whereas spondylolysis is caused by the separation of a segment of the vertebra called the pars interarticularis.
Who is at risk for pediatric skull and spine deformities?
In most cases of craniosynostosis, the cause isn't known, so it’s difficult to identify specific risk factors.
Most cases of scoliosis and kyphosis with no known cause appear in children and adolescents from 10 years old into the early teen years. The conditions are both more likely to affect girls than boys.
Children born with thin vertebral bones due to genetic factors may be at higher risk for developing spondylolysis. Also at greater risk are children who take part in sports in which the back is frequently hyperextended, such as football and gymnastics.
What are the symptoms of pediatric skull and spine deformities?
The most common sign of craniosynostosis is an irregularly shaped head that becomes apparent during the first few months of life. Depending on the area affected, that could mean a skull that appears longer and more narrow than usual, or flatter. Other symptoms include: a hard ridge that develops along an affected suture, or the early disappearance or changing appearance of the soft spot (fontanel) on the skull.
But it's important to note that a misshapen head doesn't necessarily mean a child has craniosynostosis. Far more common are so-called positional skull deformities, which are not related to growth but to the way an infant was positioned—in utero, during childbirth, or while lying down.
Plagiocephaly, also known as “flat head syndrome,” can often be corrected by regularly repositioning the baby or by using custom-fitted helmets or headbands. Those deformities do not affect brain development.
Pediatric scoliosis may cause either one or both of a child's shoulder blades to protrude prominently. The waist or shoulders may look uneven, and one hip may be higher than the other, causing the child to lean more to one side.
Kyphosis can cause a humpback look. Other signs of kyphosis may include back pain, a stiff back, and fatigue.
Spondylolysis often has no symptoms at all. When symptoms do occur, low back pain is the most common.
How are pediatric skull and spine deformities diagnosed?
Craniosynostosis is usually diagnosed during a physical exam by a neurosurgeon.
To diagnose scoliosis, kyphosis, and spondylolysis, a doctor first performs a physical exam to check the alignment of the spine. The diagnosis can then be confirmed by X-ray or other imaging tests.
What are the treatment options for pediatric skull and spine deformities?
For craniosynostosis, neurosurgery is typically the preferred treatment. Pediatric neurosurgeons team with plastic surgeons to re-contour the bones of the skull and then re-secure them, so that symmetrical growth can occur.
A child with scoliosis may need to wear a brace or have surgery, depending on how severe the curve of the spine is. The most common type of surgery to treat scoliosis is spinal fusion, in which some of the bones in the spine are linked together using a metal rod, hooks, screws, or wires to correct the abnormal curvature.
Kyphosis is also treated in a variety of ways, depending on severity. Nonsurgical treatments include a brace to adjust the spine, physical therapy to strengthen the back, and anti-inflammatory medicine for pain.
Surgical techniques similar to those used in scoliosis may be necessary if the spinal curve caused by kyphosis is severe, or if nonsurgical techniques don't work.
How is Yale Medicine’s approach to treating pediatric skull and spine deformities unique?
Yale Medicine’s pediatric neurosurgery team offers the most advanced medical care available, delivered with compassionate understanding and support. We provide comprehensive services to infants, toddlers, school-age children, adolescents, and young adults, combining our reputation for surgical excellence and innovative research program with a deep understanding of the special needs of children and families.
"Our procedures are done in concert with world renowned plastic surgeons here," says Yale Medicine neurosurgeon Kristopher Kahle, MD. "Our cosmetic results are far superior and it's because of this collaboration."
Dr. Kahle also says that Yale Medicine provides advanced molecular diagnosis of conditions.